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Table of Contents
Year : 2021  |  Volume : 23  |  Issue : 1  |  Page : 41-46

How Harmful is your personal listening device: A knowledge and attitude survey among college-going students of India

1 Department of ENT and Head and Neck Surgery, AIIMS, Guntur, Andhra Pradesh, India
2 Department of Community and Family Medicine, AIIMS, Guntur, Andhra Pradesh, India
3 Department of ENT and Head and Neck Surgery, ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India

Date of Submission25-Nov-2020
Date of Decision25-Jan-2021
Date of Acceptance31-Jan-2021
Date of Web Publication06-May-2021

Correspondence Address:
Dr. Satvinder Singh Bakshi
Department of ENT and Head and Neck Surgery, AIIMS, Guntur - 522 503, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjoh.sjoh_55_20

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Objectives: Over 1 billion people globally are at risk of hearing loss due to unsafe listening practices. The most common unsafe practice is using personal listening devices (PLDs), especially along with headphones. This study aimed to determine the knowledge regarding hearing loss due to the use of PLDs and practice concerning these devices among the college-going population (18–25 years) in India. Methodology: A cross-sectional study was conducted among college-going students aged 18–25 years. Data were collected using an anonymous web-based self-administered questionnaire. Results: A total of 255 male and 133 female students were enrolled (n = 388). Most participants listened to music more than an hour a day and 44% listened to loud and very loud music. More than half chose to ignore the warning message on their PLD and around 30% had never come across any educational material regarding the risk of hearing loss due to the use of PLDs. Conclusion: The findings indicate the need for the development of more targeted educational material and outreach programs to reduce the burden of hearing loss due to the use of PLDs.

Keywords: Health knowledge, hearing loss, personal listening devices, practice, young adults

How to cite this article:
Bakshi SS, Kalidoss VK, Ramesh S, Shankar M K. How Harmful is your personal listening device: A knowledge and attitude survey among college-going students of India. Saudi J Otorhinolaryngol Head Neck Surg 2021;23:41-6

How to cite this URL:
Bakshi SS, Kalidoss VK, Ramesh S, Shankar M K. How Harmful is your personal listening device: A knowledge and attitude survey among college-going students of India. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2021 [cited 2022 Dec 4];23:41-6. Available from: https://www.sjohns.org/text.asp?2021/23/1/41/315576

  Introduction Top

One of the major but yet underdiagnosed public health problems in the world is noise-induced hearing loss (NIHL). Mostly, NIHL has been associated with occupational noise exposure in adults; however, there is an increasing trend of NIHL in children and adolescents. One of the earlier studies which identified this was carried out by Niskar et al.,[1] who estimated that 12.5% of the children aged 6–19 years have noise-induced threshold shifts. Furthermore, studies from the United Kingdom,[2] France,[3] and Sweden[4] have also reported evidence of NIHL in children and young adults. NIHL in children and young adults has been linked to recreational noise and leisure activities. The most common recreational noise exposure comes from the use of personal listening devices (PLDs). Lee et al.[5] found that transient threshold shifts _10 dB could be seen after listening to headphones for 3 h at normally used output levels. This preventable hearing loss poses a great challenge to the society as it affects the communication and social skills of this young generation and ultimately reduces their job opportunities and output. Despite the obvious evidence of the hazards of loud noise exposure from these devices, there are no guidelines or regulations to reduce exposure from the same. Besides this, PLD is becoming cheaper, lighter, and smaller, thereby increasing their popularity. The most common group exposed to this hazard is college students. Hence, we planned a study to survey college students regarding their experience and attitude toward the use of PLD. We hope that the result of this survey may help us formulate better educational material, resources, and outreach campaigns for preventing hearing loss from PLD.

  Methodology Top

An anonymous online-based cross-sectional survey was conducted among young adults aged 18–25 years during April–May 2020. This age group was chosen as these people represent the college-going age and are more likely to use personal audio devices. A structured study questionnaire was developed with domains of PLDs use, knowledge, and attitude about the effect of PLD usage on hearing. The study tool contains a total of 23 items; out of them, 10 items were on the practice domain, 11 items on the knowledge domain, and 2 items on the attitude domain. The questionnaire was pretested on 10 young adults, and necessary modifications were done based on piloting and feedback. The study questionnaire was made in Google Forms and sent to participants through E-mail. Instructions on filling the form were also sent and filling the form implied consent. Responses from participants who do not use PLDs and partly filled questionnaires were excluded. Total 1634 responses were received. After screening, 1594 data were included for analysis [Figure 1].
Figure 1: Flowchart depicting the methodology

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Statistical analysis

The data were exported into MS Excel and analyzed using R software [Developer R core team, version 4.0.4, Vienna, Austria]. The categorical variable was summarized as frequency and proportions. The multiple response questions were expressed as bar diagrams. The association between the categorical variables was analyzed using the Chi-square test, and P < 0.05% was considered as statistically significant.

  Results Top

A total of 1596 complete responses were analyzed, of which 52% were male and 55% were aged more than 20 years [Table 1]. Majority used phone (96.2%) as PLDs for listening to music following television (TV) (34%) and computer (28.3%) [Figure 2].
Table 1: Demography distribution of the study participants

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Figure 2: Types devices used by the participants to listen to music

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Sixty-seven percent of the study participants were listening to music daily and more than half of them were listening to music more than 1 h and one-fifth more than 2 h a day [Table 2]. On loudness Likert scale of 1–5, 43% of the study participants reported that they listened to music at a scale of 3% and 31% reported a scale of 4. Around 39% of the study participants reported that at some time, someone has asked them to reduce the volume of the music. Almost all the participants were using headphones/earphones. Three-fourth of the study participants used a headphone to listening to music during relaxation and half of them reported using headphones for academics [Figure 3]. In terms of loudness scale, the majority of the study participants reported the volume of the headphone as 3 (42.2) and 4 (31.3) on a Likert scale of 1–5. We also found that around 60% of the study participants used headphones for more than an hour a day. Seventy percent of the study participants were aware that noise has an effect on health and 61% knew that listening to loud music can cause permanent hearing loss even in young people. One-third of the study participants thought that they were at risk of hearing loss due to listening to loud music. Only 46% knew that turning up the volume on TV or radio is a sign of hearing loss. Sixty-five percent agreed that simply reducing the volume of the device will reduce the risk of hearing loss [Figure 4], 70% agreed that simply reducing total duration of use will reduce the risk of hearing loss, and 68% reported that reducing both volume and duration of music will reduce the risk of hearing loss. Around 35.7% had experienced at least one hearing-related health problem; the most common issue was headache in 20%, followed by ear pain in 14% [Figure 5]. A good number (89%) were familiar with volume-limiting (or safe listening) features on personal music devices. Half of the study participants reduced the volume when warning message regarding “high volume” while using headphone came in their listening device [Figure 6]. Only 68% had received any information on the harmful effects of PLDs on hearing and health. The major sources of information were the Internet (57.6%), friends (47%), and mass media (44.7%). Only 37.9% had received information from the doctor or health-care worker [Table 3].
Table 2: Practice on listening to music and usage of personal listening devices by study participants

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Table 3: Knowledge on effect of personal listening devices on hearing

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Figure 3: Distribution of activities during which headphones/earphones were used

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Figure 4: Distribution of symptoms experienced by study participants

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Figure 5: Action taken when the warning message regarding “high volume” comes while using headphones/earphones

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Figure 6: Knowledge on measures to reduce hearing loss due to personal listening devices

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  Discussion Top

PLDs have become increasingly popular, especially after their integration into mobile phones. These devices are capable of producing high output levels that can cause hearing loss.[6],[7] This is particularly dangerous for adolescents and young adults as they begin using them at an early age, thereby exposing themselves to risk for future NIHL.[8] Many times, these people are unaware that hearing loss is developing.[9] An estimated 5%–10% of young users of PADs are at high risk of developing hearing loss after 5 or more continuous years of PAD use for music listening purposes.[10] According to the World Health Organization (WHO), more than one billion young people worldwide could be at risk of hearing loss due to unsafe listening practices and that nearly half of all teenagers and young adults in middle- and high-income countries are exposed to unsafe sound levels from the use of PLDs.[11]

We did not find a significant difference between males and females concerning the duration of PLD use or the volume at which it was used. As in previous studies,[12] there were no major gender gaps in terms of length and amount of use of PLD. However studies by Hussain et al.[8] and Basu et al.[13] found that males used PLD for a longer time and at louder volumes.

This study showed that almost 50% of the students listened to music for more than 1 h a day and 20% more than 2 h a day. Besides, around 44% listened to loud and very loud music (rating of 4 or 5 on the Likert scale). This is in agreement with that of Narahari PG et al. who found one-third of the adolescent students in Iran listening to music on PLD for >2 h a day.[14] In the study by Levey et al.,[15] more than half of PLD users at a New York college exceeded recommended sound exposure limits. In the study by Seedat et al., 52.7% of the health science students used PLD for more than 2 h per day and the use was at a high volume in 14.9%.[16]

A disturbing trend that was found is that although most of the participants were aware of the safety features on their PLD, many ignore the warning (38%) and some even continue to increase the volume (11%) even after the warning message comes. Around 54% were not aware that having to turn up the volume on TV or radio was a sign of hearing loss. This points to a deficiency in the current educational programs and must be addressed. The basis of the warning message and the need to react appropriately when the message comes should be emphasized.

Around 30% of the participants had never come across any educational resource regarding the use of PLD and hearing loss. The Internet was the source of information in only 57% of the participants who had come across educational material indicating a possible deficiency of resource material on the Internet and the urgent need for more educational resources and outreach programs on the harmful effect of using PLD.

We found that although most of the participants agreed that reducing both the volume and the usage of PLD was important in preventing hearing loss, around 24% believed that only one of the methods was enough. Therefore, health messages should avoid focusing only on volume reduction as a single solution. Rather, hearing health messages may be more effective if a flexible approach is taken that promotes decreasing listening volumes and/or decreasing durations.

Since participation in the survey was voluntary, bias can occur in the selection of participants. The survey will be filled only by individuals with access to technology and who are comfortable filling it out. The survey was conducted in English, which is also a limiting factor. We are planning to survey vernacular language also in the future. Furthermore, the survey depended on the participants' ability to recall past events accurately and provide an estimated average regarding their behaviors. Furthermore, we did perform any audiological test on the participants to determine if their symptoms were due to the use of PLD. There are many other sources of loud music such as rock concerts and loudspeakers from places of worship which were not evaluated.

A step in the right direction is the Make Listening Safe initiative launched by the WHO in 2015.[17] This initiative aims to reduce the risk of hearing loss due to unsafe exposure to sounds in recreational settings by regulating exposure to loud sounds through personal audio systems, undertaking a public awareness campaign to change listening behaviors, and developing a regulatory framework for safe listening in recreational settings.

Recommendations have been developed by the WHO and the International Telecommunication Union, which involve the creation of a personal profile on devices that will provide information how securely (or not) the user has been using the device, with volume-limiting choices like parental controls and development of sound allowance software which monitors the PLD's level and use.[18] Although voluntary, we believe that these recommendations should be strictly enforced to reduce the global burden of hearing loss.

  Conclusion Top

NIHL due to the use of PLDs is on the rise. College-going students represent one at the greatest risk for developing this type of hearing loss. The awareness about the risk of using these PLDs is low, especially in terms of duration of usage and level of sound. More educational resources should be made available and awareness campaigns targeting college students ought to be conducted in order to mitigate this risk.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Niskar AS, Kieszak SM, Holmes AE, Esteban E, Rubin C, Brody DJ. Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: The Third National Health and Nutrition Examination Survey, 1988-1994, United States. Pediatrics 2001;108:40-3.  Back to cited text no. 1
Sadhra S, Jackson CA, Ryder T, Brown MJ. Noise exposure and hearing loss among student employees working in university entertainment venues. Ann Occup Hyg 2002;46:455-63.  Back to cited text no. 2
Meyer-Bisch C. Epidemiological evaluation of hearing damage related to strongly amplified music (personal cassette players, discotheques, rock concerts) – High-definition audiometric survey on 1364 subjects. Audiology 1996;35:121-42.  Back to cited text no. 3
Costa OA, Axelsson A, Aniansson G. Hearing loss at age 7, 10 and 13 – An audiometric follow-up study. Scand Audiol Suppl 1988;30:25-32.  Back to cited text no. 4
Lee PC, Senders CW, Gantz BJ, Otto SR. Transient sensorineural hearing loss after overuse of portable headphone cassette radios. Otolaryngol Head Neck Surg 1985;93:622-5.  Back to cited text no. 5
Portnuff CD. Reducing the risk of music-induced hearing loss from overuse of portable listening devices: Understanding the problems and establishing strategies for improving awareness in adolescents. Adolesc Health Med Ther 2016;7:27-35.  Back to cited text no. 6
Sulaiman AH, Husain R, Seluakumaran K. Hearing risk among young personal listening device users: Effects at high-frequency and extended high-frequency audiogram thresholds. J Int Adv Otol 2015;11:104-9.  Back to cited text no. 7
Hussain T, Chou C, Zettner E, Torre P, Hans S, Gauer J, et al. Early indication of noise-induced hearing loss in young adult users of personal listening devices. Ann Otol Rhinol Laryngol 2018;127:703-9.  Back to cited text no. 8
Levey S, Fligor B, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord 2012;39:76-83.  Back to cited text no. 9
Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise Health 2012;14:274-80.  Back to cited text no. 10
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World Health Organization. Hearing Loss due to Recreational Exposure to Loud Sounds: A Review. Geneva: World Health Organization; 2015.  Back to cited text no. 11
Hutchinson Marron K, Marchiondo K, Stephenson S, Wagner S, Cramer I, Wharton T, et al. College students' personal listening device usage and knowledge. Int J Audiol 2015;54:384-90.  Back to cited text no. 12
Basu S, Garg S, Singh MM, Kohli C. Knowledge and practices related to the use of personal audio devices and associated health risks among medical students in Delhi. J Educ Health Promot 2019;8:42.  Back to cited text no. 13
Narahari PG, Bhat J, Nambi A, Arora A. Impact of usage of personal music systems on oto-acoustic emissions among medical students. Noise Health 2017;19:222-6.  Back to cited text no. 14
[PUBMED]  [Full text]  
Levey S, Levey T, Fligor BJ. Noise exposure estimates of urban MP3 player users. J Speech Lang Hear Res 2011;54:263-77.  Back to cited text no. 15
Seedat RY, Ehlers R, Lee Y, Mung'omba C, Plaatjies K, Prins M, et al. Knowledge of the audiological effects, symptoms and practices related to personal listening devices of health sciences students at a South African University. J Laryngol Otol 2020;134:20-3.  Back to cited text no. 16
World Health Organization and International Telecommunication Union. Toolkit for Safe Listening Devices and Systems. Geneva: World Health Organization and International Telecommunication Union; 2019.  Back to cited text no. 17
World Health Organization and International Telecommunication Union. Safe Listening Devices and Systems: A WHO-ITU Global Standard. Geneva: World Health Organization and International Telecommunication Union; 2019.  Back to cited text no. 18


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

  [Table 1], [Table 2], [Table 3]


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